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Claiming Compensation for Occupational Injuries or Diseases

Description:

Workers who are injured or contract a disease through their work are able to claim money from the Compensation Fund. Families can also claim if their breadwinner died through work related disease or injury.

There are certain categories of worker who cannot claim from the fund. For example, you cannot claim if you are:

a domestic worker employed at a private home

a member of the South African National Defence Force (there is a separate fund)

a member of the South African Police Services (there is a separate fund)

a worker who doesn't work under the control of your employer

a worker who works outside South Africa for more than 12 months at a time.

You can claim if you are:

a domestic worker in a boarding house

an apprentice or trainee farm worker

a worker paid by a labour agency.

Claims will only be paid if they are submitted in the correct way in the proper time. Claims will not be paid if:

The claim is made more than 12 months after the accident or death, or after the disease is diagnosed.

You are off work for 3 days or less.

The accident resulted from your own wrong doing (Unless the worker is seriously disabled or dies in the accident, then the Fund will still pay compensation).

You unreasonably refuse to have medical treatment.

WHO PAYS INTO THE FUND?

Employers pay into the Compensation Fund once a month. Workers do not pay anything to the Fund. Employers cannot deduct money from workers' wages as contributions to the Fund.

WHAT INJURIES AND DISEASES ARE COVERED?

The Fund covers occupational diseases and workplace injuries.

Occupational diseases are illnesses caused by substances or conditions that the worker was exposed to at the workplace. You can claim compensation if you are exposed to these working conditions and then get the related disease.

The working conditions and diseases caused by these conditions that are covered by the Compensation Fund are set out in Schedule 3 of the Act.

You can claim for other disease if you can prove using medical evidence and reports that the disease was caused by conditions at work.

The Fund also covers injuries that were sustained as a result of work or at the workplace.

The Compensation Fund does not pay for pain and suffering, only for loss of movement or use of your body.

The amount of compensation that will be paid to the worker depends on how much the worker was earning when the injury was sustained or the disease diagnosed. If you are have stopped working by the time a disease is diagnosed, the compensation will be worked out according to what you would have been earning.

TEMPORARY DISABILITY

What is temporary disability?

Temporary disability is when you are unable to work or cannot do all your work because of an injury or disease but you will get better.

To claim for this, you need to be put off work by a doctor for more than three days. If you are put off work for longer than three days, you will get paid out for the whole time that you are unable to work (including the first three days).

What do you get paid?

If you cannot work at all, you will get paid out 75% (¾) of your normal monthly or weekly wage.

If you can only do some of your work, you will still get paid some wages by your employer. The Fund will pay you 75% (¾) of the difference between what you got paid and what you would have been paid before the injury.

All medical expenses are also paid if the accounts are submitted to the Commissioner.

How long can you claim for?

You can claim compensation for temporary disability for 12 months. This can be extended to 24 months. After 24 months the Commissioner may decide that the condition is permanent and grant compensation on the basis of permanent disability.

PERMANENT DISABILITY

What is permanent disability?

A permanent disability is an injury or illness that the worker will never recover from, for example, losing an eye. The serious of the disability will determine whether the worker will never be able to work again or whether they will find work more difficult.

Disabilities are rated from 100% to 1% depending on the seriousness. For example, a 100% would be the loss of both your hands or the loss of your sight. The loss of your small toe is a 1% disability.

Your doctor will write a medical report about the disability. The Commissioner and various other doctors will then decide how serious the disability is.

How much compensation do you get?

If the disability is more than a 30% disability, you will get paid a monthly pension. The size of the pension depends on what your wages were and on the seriousness of the disability. If you have a 100% disability you will get paid 75% (¾ ) of your wages. If the disability is less serious, the following formula is used to work out the monthly payment: [wages * (75 ÷ 100)] * (disability% ÷ 100).

If the disability is less than a 30% disability, you will get paid a lump sum.

How long will the compensation be paid for?

The lump sum payment is a once off payment. The monthly payment will be paid for the rest of the worker's life.

DEATH BENEFITS

If the bread-winner in your family was killed by an occupational injury or disease, you can claim from the Fund.

How much can you claim?

The amount of compensation that you will be paid depends on your relationship to the deceased. The total amount paid to the family cannot be more than the pension the deceased worker would have received if he/she was ¾ of the worker's wages per month.

The spouse will be paid:

a lumps sum of 2 x ¾ of the worker's wages

a monthly pension for life of 40% x ¾ of the worker's wages.

The worker's children under the age of 18 (including illegitimate, adopted and step children) are entitled to a monthly pension of 20% x ¾ of the worker wages. This is paid every monthly until the child is 18 years old. This pension can continue for longer if the child is mentally or physically handicapped.

If there is no spouse or children, other dependents will be paid compensation (for example, parents). People who were fully dependent on the worker get the same as the widow. People who were partially dependent on the worker get a once off payment that depends on how dependent they were on the worker.

The person who pays for the funeral expenses will be paid expenses up to R6 970.

To claim compensation for the death of a family member, you need to provide certified copies of:

marriage certificate

children's birth certificates

death certificate

declaration by the spouse (form WCL32)

the employer's incident report

funeral accounts (form WCL46)

details of your income and property.

MEDICAL EXPENSES

All the medical expenses of a worker will be paid for up to two years from the date of the accident or the diagnosis of the disease. All medical accounts should be submitted to the Commissioner. This includes fees for transporting an injured employee to a hospital or to their home.

ADDITIONAL COMPENSATION

In addition to the general compensation, you can get extra compensation if the injury or disease was caused by the employer's negligence or a fault with a machine. Any worker who is under 26 years will get extra compensation.

Instructions:

HOW DO YOU CLAIM?

Inform you supervisor or employer as soon as possible (verbally or in writing). Make note of anyone who witnessed the accident.

The form that needs to be completed is WCL 2: Notice of Accident and Claim for Compensation.

The employer must then report the accident to the Compensation Commissioner, even if they doesn't believe the worker's story, by submitting Form WCL 3: Employer's Report of Accident.

The employer must report a workplace injury within 7 days or within 14 days of finding out that the worker has an occupational disease.

The employee should check that all the details on the form are correct.

Within 14 days of seeing the worker, the doctor must fill in form WCL4 stating how serious the injury was and how long the worker is likely to be off work. This is sent to the employer who sends it to the Commissioner.

The worker does not pay for the doctor's fees. But if you want a second opinion, you will have to pay for this.

If the injury will take a long time to heal, the doctor must send a progress report (WCL 5) to the Commissioner every month until the condition is fully stabilised. This informs the Commissioner of how long the worker is off work.

Finally the doctor must submit a final doctor's report (WCL5) stating either that the worker is fit to go back to work or that the worker is permanently disabled. The doctor must send this form to the employer who sends it to the Commissioner.

When the worker goes back to work, the employer must send a resumption report (WCL6) to the Commissioner stating when the worker went back to work and how much the worker was paid in compensation.

The worker and the employer should keep copies of all the forms.

When the first doctor's report has been submitted with the accident report, the Compensation Commissioner will consider the claim and make a decision. A claim number will also be allocated. This number should be used for all paperwork relating to a claim.

If the worker disagrees with the decision, they can appeal the decision within 90 days by submitting form W929 to the Commissioner.

All forms that need to be submitted to the Commission can be sent to:

Compensation CommissionerPO Box 955Pretoria0001

You can contact the Commissioner or any Regional Office of the Department of Labour for more information and for assistance. Forms are available from: